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General NPI Number Information
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NPI Number | 1457349946
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Entity Type | Individual
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Provider Name | ROBERT BRUCE WILLIAMS MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 2915 MISSOURI AVE
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City | SHREVEPORT
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State | LA
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Zip | 71109-4327
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Country | US
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Telephone | 318-364-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9600 DEPT. 09-021
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City | TEXARKANA
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State | TX
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Zip | 75505-9600
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Country | US
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Telephone | 318-868-0932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 03815R
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License Number State | LA
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